**6.3 The role of increased physical activity and exercise in the management of diabetes mellitus**

Physical inactivity and sedentary lifestyle are one of the risk factors for noncommunicable diseases and obesity and obesity is a risk factor for diabetes mellitus. There are short and long term advantages of physical activity including exercise and this cause a reduction of illnesses with obesity and physical inactivity as its predisposing factors including diabetes mellitus [24]. According to the results of several meta-analytical epidemiological studies on physical exercise including the Diabetes Prevention Programme (DPP) in the United States, diet and exercise and other components of lifestyle medicine causes a reduction in the progression of impaired glucose tolerance (IGT) in Type 2 Diabetes Mellitus [44].

During physical activity and exercise, it acts as physical stress on the body thereby leading to changes in the transportation of glucose thereby satisfying the increased energy demand that occurs during exercise [8]. Hence among the core components of lifestyle medicine in the management of diabetes mellitus [12]. Results of some observational studies have revealed that one of the non-invasive therapies for the prevention and management of diabetes mellitus is exercise; this extends to pregnant women, hence exercise also serves as a preventive measure and for management of gestational diabetes mellitus [45] low impact exercises can be done by pregnant women.

In diabetes mellitus, there is an inadequate amount of insulin and hyperglycaemia also results from increased insulin resistance [19]. Insulin resistance is promoted by obesity and physical inactivity. In the muscles that are not exercised, deposition of visceral fat and also deposition of fat in the liver and muscle occurs by the sequestration of glucose transporter 4 (GLUT-4) [8]. This deposition of fat increases obesity and also worsens insulin resistance. Exercise burns off deposited fat which will definitely in turn positively affect insulin resistance. Improvement of the tolerance of glucose, reduction of insulin resistance and improvement in the lipid profile occurs during exercise thereby increasing and improving cardiovascular and cardiopulmonary function [10]. This improves the sensitivity of insulin and also helps in weight loss, which in turn improves the overall wellbeing of the diabetic and also serves as a preventive measure of other non-communicable diseases [5, 10, 45]. It also stimulates the uptake of glucose. In a study conducted by Miyauch et al. [46], the levels of glycosylated hemoglobin were decreased was seen in patients who engage in an exercise regimen [46]. The aims of exercise in both the prevention and management of Type 2 Diabetes Mellitus are to achieve good metabolic control of diabetes mellitus, weight reduction, increased physical activity, improvement of the cardiovascular function, improvement in dyslipidaemia by reduction of the blood lipids and the general sense of wellbeing and quality of life [10]. Exercise is also necessary for the management of Type 1 Diabetes Mellitus.

Mechanism of improvement of blood glucose through exercise therapy [18]:


The recommended international guidelines for exercise for adults 18 years and above is to engage in an exercise of moderate intensity for 150 minutes or aerobic exercise and physical activity of vigorous activity for 15 minutes weekly. This can be done as episodes of ten minutes including exercises that strengthen the body involving the major groups of muscles performed on two or more days per week [8]. An exercise regimen begins with a warm-up exercise to stimulate the muscles followed by the conditioning phase and ending with the cooling-down phase. All the phases of exercise are important to prevent injury and muscle soreness. Exercise can act as medicine to the body but diabetics should still be counseled on taking their medications and not to avoid regular check-ups. Diabetics should avoid high impact and vigorous exercises except under the guidance of a physician. Diabetics who should not participate in exercises:

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**7. Conclusion**

*The Role of Lifestyle Medicine in the Management of Diabetes Mellitus*

Exercise is very important in the prevention of Type 2 Diabetes Mellitus, it is also important in the management of Type 1, 2 and gestational diabetes mellitus [10, 18, 38].

**6.4 The role of eating whole plant-based diet in the prevention and management** 

Eating a whole plant-based diet involves eating meals composed of plants and removing processed meals, animal and animal products, high salt, sugar and fat. This is because they are all risk factors for non-communicable diseases and diabetes mellitus. These meals are referred to as unhealthy foods because of the negative effects. Consumption of a whole plant-based diet involves eating food rich in fruits, vegetables, and legumes. Fruits, vegetables and legumes are available globally and should be encouraged. Good nutrition is very important in any lifestyle intervention [24]. In whole food plant-based diet, consumption of fruits, legumes, whole grains, including nuts and seeds are emphasized. Also, the consumption of animal products and unhealthy foods such as red and white meat, poultry, fish, eggs, dairy products, refined and processed meal, added sugars and oils are minimized and if possible eliminated from the diet [11]. It has been shown that vegetarians who do not eat any animal product have a low prevalence of diabetes mellitus 2.9% with omnivores having a prevalence of 7.6%. Various data have shown between the consumption of processed meat such as bacon, sausage, and hot dog including consumption of eggs and diabetes mellitus [9]. Counseling patients on nutrition is very important in the management of diabetes mellitus. Every diabetic should always have a counseling session during their follow-up visit which should include diet from food available in the locality. The etiology of a wide range of diseases is linked to diet. One of the fundamental determinants of human health is the amount and type of food consumed [5]. It is very important to balance calorie intake and physical activity as a strategy to maintain an ideal weight and preventing overweight obesity and chronic diseases [3]. To fill up the satiety while consuming low calories, complex carbohydrates with a low glycaemic index should be consumed. Other dietary restrictions such as fasting improve the blood glucose but it should be done under the supervision of a physician preferably an endocrinologist and a diabetologist if available to avoid rebound hyperglycaemia which can lead to non-diabetic ketoacidosis and hyperglycemic hyperosmolar state. Intermittent fasting can be practised by diabetics as it is

Decreased consumption of fruits and vegetables is associated with metabolic syndrome [11]. Nutrition is very important in the practice of lifestyle medicine, various guidelines on nutrition for diabetes mellitus have recommended diets lows in red and processed meat, refined grains, added sugar, food sweetened with sugar

Lifestyle medicine promotes the eating of whole plant based diet which is one of the pillars of lifestyle medicine. There are various other diets plans that has been found to be beneficial in the management of diabetes mellitus such as the low glycaemic diet, dietary approaches to stop hypertension diet (DASH) and the Mediterranean diet. In a study conducted by Paula et al. [47], they found out when the DASH diet was combined with walking, the result is a reduction in the ambulatory blood pres-

Diabetes mellitus is a non-communicable disease that can be prevented and managed using lifestyle modification which involves eating a diet that is rich in

sure monitoring in hypertensive patients with diabetes mellitus [47].

*DOI: http://dx.doi.org/10.5772/intechopen.99555*

**of diabetes mellitus**

effective but not strict fasting [11].

and salts and saturated and trans-fat [3].


*Type 2 Diabetes - From Pathophysiology to Cyber Systems*

done by pregnant women.

Mellitus.

• Increased intake of glucose

• Increased utilization of glucose

• Protection of the function of beta cells of the pancreas

• Improved insulin sensitivity

not participate in exercises:

1.Diabetics with retinopathy

2.Diabetics with neuropathy

3.Recurrent hypoglycaemia

4.Recurrent hyperglycaemia

for management of gestational diabetes mellitus [45] low impact exercises can be

In diabetes mellitus, there is an inadequate amount of insulin and hyperglycaemia also results from increased insulin resistance [19]. Insulin resistance is promoted by obesity and physical inactivity. In the muscles that are not exercised, deposition of visceral fat and also deposition of fat in the liver and muscle occurs by the sequestration of glucose transporter 4 (GLUT-4) [8]. This deposition of fat increases obesity and also worsens insulin resistance. Exercise burns off deposited fat which will definitely in turn positively affect insulin resistance. Improvement of the tolerance of glucose, reduction of insulin resistance and improvement in the lipid profile occurs during exercise thereby increasing and improving cardiovascular and cardiopulmonary function [10]. This improves the sensitivity of insulin and also helps in weight loss, which in turn improves the overall wellbeing of the diabetic and also serves as a preventive measure of other non-communicable diseases [5, 10, 45]. It also stimulates the uptake of glucose. In a study conducted by Miyauch et al. [46], the levels of glycosylated hemoglobin were decreased was seen in patients who engage in an exercise regimen [46]. The aims of exercise in both the prevention and management of Type 2 Diabetes Mellitus are to achieve good metabolic control of diabetes mellitus, weight reduction, increased physical activity, improvement of the cardiovascular function, improvement in dyslipidaemia by reduction of the blood lipids and the general sense of wellbeing and quality of life [10]. Exercise is also necessary for the management of Type 1 Diabetes

Mechanism of improvement of blood glucose through exercise therapy [18]:

The recommended international guidelines for exercise for adults 18 years and above is to engage in an exercise of moderate intensity for 150 minutes or aerobic exercise and physical activity of vigorous activity for 15 minutes weekly. This can be done as episodes of ten minutes including exercises that strengthen the body involving the major groups of muscles performed on two or more days per week [8]. An exercise regimen begins with a warm-up exercise to stimulate the muscles followed by the conditioning phase and ending with the cooling-down phase. All the phases of exercise are important to prevent injury and muscle soreness. Exercise can act as medicine to the body but diabetics should still be counseled on taking their medications and not to avoid regular check-ups. Diabetics should avoid high impact and vigorous exercises except under the guidance of a physician. Diabetics who should

**316**

Exercise is very important in the prevention of Type 2 Diabetes Mellitus, it is also important in the management of Type 1, 2 and gestational diabetes mellitus [10, 18, 38].
